@layout("/common/_form.html",{js:["/assets/modular/system/btyZxBaoxiaodanAudit/btyZxBaoxiaodanAudit_add.js"],css:["/assets/expand/module/formSelects/formSelects-v4.css"]}){

<form class="layui-form" id="btyZxBaoxiaodanAuditForm" lay-filter="btyZxBaoxiaodanAuditForm">
    <div class="layui-fluid" style="padding-bottom: 75px;">
        <div class="layui-card">
            <div class="layui-card-header">基本信息</div>
            <div class="layui-card-body">
                <div class="layui-form-item layui-row">
                    <input name="id" type="hidden"/>

                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">店名<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="shopName" name="shopName" placeholder="请输入店名" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">报销人<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="userName" name="userName" placeholder="请输入报销人" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">报销人ID<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="userId" name="userId" placeholder="请输入报销人ID" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">货品统称备注<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="productRemark" name="productRemark" placeholder="请输入货品统称备注" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">申请日期<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="applyDate" name="applyDate" placeholder="请输入申请日期" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">审核时间<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="auditTime" name="auditTime" placeholder="请输入审核时间" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">驳回原因<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="reason" name="reason" placeholder="请输入驳回原因" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">状态 1.待提交，2.工程审核中，3.工程驳回，4.财务审核中，5.财务驳回，6.待打款，7.已打款；<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="status" name="status" placeholder="请输入状态 1.待提交，2.工程审核中，3.工程驳回，4.财务审核中，5.财务驳回，6.待打款，7.已打款；" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">文件url<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="fileUrl" name="fileUrl" placeholder="请输入文件url" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">报销档案ID<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="bxdaId" name="bxdaId" placeholder="请输入报销档案ID" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">报销金额<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="reimbursementAmount" name="reimbursementAmount" placeholder="请输入报销金额" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">打款金额<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input id="remitAmount" name="remitAmount" placeholder="请输入打款金额" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
    <div class="form-group-bottom text-center">
        <button class="layui-btn" lay-filter="btnSubmit" lay-submit>&emsp;提交&emsp;</button>
        <button type="reset" class="layui-btn layui-btn-primary" id="cancel">&emsp;取消&emsp;</button>
    </div>

</form>

@}